The Impact of Histological Clot Composition in Embolic Stroke

Abstract

Our results suggest that thrombi with a high WBC fraction are related to more organized thrombi of cardioembolic origin associated with less favorable recanalization and clinical outcome in acute ischemic anterior circulation stroke. WBC-mediated immunological and coagulatory processes may play a key role in thrombus formation and pathogenesis of stroke warranting further investigation.

Ischemic Stroke

“…This supports recent studies by Boeckh-Behrens et al, 8,10 Niesten et al, 13 and Simons et al, 7 that report about an association of high fibrin and low RBC proportion in cardioembolic thrombi and which are contrary to the concept of red and erythrocyte-rich cardioembolic thrombi (Figure 1). The contradictory findings of Kim et al 14 may be related to differences in methods and study population.…”

“…[3][4][5][6][7][8][9] Moreover, first results about the differentiation of cardioembolic versus noncardioembolic stroke suggest that cryptogenic stroke is mostly of cardiac origin. 8,10 However, evidence is limited, especially for immunohistochemical parameters. 11 Our study, therefore, aimed to evaluate further the theory of histological determination of thrombus origin and additionally included immunohistochemical parameters that may help to specify the thrombus origin.…”

Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke: Correlation with Stroke Etiology and Gradient-Echo MRI

“…To date, very few studies investigating a possible relationship between the histology of retrieved clots and stroke mechanisms have been reported. [8][9][10] Moreover, the results of previous studies have been inconsistent and confusing. Liebeskind et al 10 performed histopathologic analysis of retrieved clots in 50 patients with acute ischemic stroke who had undergone endovascular thrombectomy.…”

“…Recent studies suggested that histologic examination of retrieved clots can offer new insights into the pathogenesis of acute stroke due to intracranial large-vessel occlusion. [6][7][8][9] However, it is currently unclear whether clot-composition analysis is helpful to predict a stroke mechanism in acute large-vessel occlusion. Only a few studies have been conducted on this topic, and prior studies have yielded only vague and contradictory results.…”

“…Only a few studies have been conducted on this topic, and prior studies have yielded only vague and contradictory results. [8][9][10] In addition, histopathologic analysis of retrieved clots allows understanding of the pathologic basis of early vessel signs on imaging studies in patients with acute ischemic stroke. Several studies have shown that the hyperattenuated vessel sign on CT and the susceptibility vessel sign on gradient-echo (GRE) MR imaging were more often associated with erythrocyte-rich thrombi (red thrombi) than fibrin-rich thrombi (white thrombi).…”